Table of Content

05 March 2023, Volume 26 Issue 07

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Editorial

A Recommended "Dementia Prevention and Treatment Action Plan" Task List for China: WHO Global Action Perspective

YANG Haopeng, SUO Jingdong, SHEN Xianlei, WANG Dan, ZHU Xuemin, LIU Yuehua, LIANG Wannian

2023, 26(07):  775-779.  DOI: 10.12114/j.issn.1007-9572.2022.0744

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As a major public health problem, dementia has attracted great global attention. Early detection and interventions targeting high-risk people of cognitive impairment, can help prevent the onset of dementia and postpone its progression. The rapid increase in the number of elderly people with dementia in China poses challenges in terms of preventive care, health promotion, social support and research innovation. So it is essential to develop a national task list of dementia prevention and treatment action plan, yet it is still in an exploratory stage. In this paper, on the basis of the review of the WHO "Global Action Plan for Public Health Response to Dementia 2017—2025", we proposed a list of tasks of "Dementia Prevention and Treatment Action Plan" for China from the perspective of WHO's global action according to current China's policies and practices and the focuses in dementia prevention and treatment and actual resources, which covers risk factor intervention, person-centred care, social support, information system construction, innovative research and science and technology transformation. It is expected that this action plan will inform relevant dementia prevention and treatment decisions as well as practical responses.

Prevention and Control of the COVID-19 Epidemic and Management of Chronic Disease

YANG Hui

2023, 26(07):  780-782.  DOI: 10.12114/j.issn.1007-9572.2022.W0005

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During the prevention and control of the COVID-19, the decrease in routine medical care has spread across countries in various degrees, also affecting the management of chronic disease accordingly. The policies and schemes of prevention and control of the COVID-19 in China have been adjusted since December 2022, health care system has been facing serious challenges, bringing increased pressure on primary care. Based on the experiences of other countries, this paper suggests that primary care in China should pay attention to the promoting of self-management for patients with chronic diseases, providing proactive service for patients with complex situations and high demand, strengthening the application and research of telemedicine, intensifying the community connection of primary care services, focusing on the improvement of the compensation mechanism of health services.

Original Research·Focus on Diet Management after Bariatric Surgery

Maladaptive Eating Behavior after Bariatric Surgery: a Conceptual Analysis

HUA Hongxia, LIANG Hui, XU Xinyi, XU Qin, SONG Yating, YANG Ningli

2023, 26(07):  783-789.  DOI: 10.12114/j.issn.1007-9572.2022.0509

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Background

Maladaptive eating behavior after bariatric surgery is an im-portant cause of postoperative weight regain. However, the depth and reliability of its related research has been greatly hindered partially by non-unification of its concept and inappro-priate words used to explain the concept.

Objective

To clarify the concept of maladaptive eating behavior after bariatric surgery.

Methods

In May 2022, database of CNKI, WanFang Data, SinoMed, PubMed, Web of Science and CINAHL were systematically searched for studies in Chinese or English mainly about maladaptive eating behavior after bariatric surgery from inception to May 10, 2022, involving related concepts, definition attributes, antecedents and consequences. The contents of included literature were analyzed using the Rodgers' process of concept analysis, involving the evolution, attributes, antecedents, consequences, related concepts, typical case, assumptions and enlightenment for further development.

Results

Altogether, 36 studies were included, 33 of which in English, and the other three were in Chinese. The conceptual attributes of maladaptive eating behavior after bariatric surgery were composed of six aspects: uncontrolled eating, grazing, emotional eating, food craving, food addiction and compensatory behaviors. The antecedents include subjective factors (containing self-efficacy, dietary attitude, psychological status, work pressure and so on) , and objective factors (containing age, gender, education level, obesity history and others) . Eating disorders, mental illness, weight-loss outcome, nutritional status and quality of life compose the consequences.

Conclusion

The concept of maladaptive eating behavior after bariatric surgery is still non-unified. Its meanings in China should be discussed according to the national condition, and in-depth research on relevant theories, assessment tools, influencing factors and intervention should be conducted on this foundation, so as to maintain the effect of bariatric surgery and improve the quality of life in these patients.

Dietary and Physical Activity Behavior Promotion Strategies after Bariatric Surgery from a Cognitive Perspective: an Integrative Review

ZHAO Kang, ZHU Hanfei, XU Ting, MIAO Xueyi, JIANG Xiaoman, XU Qin

2023, 26(07):  790-799.  DOI: 10.12114/j.issn.1007-9572.2022.0670

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Background

With the growing problem of obesity, the demand for bariatric surgery has increased these years. Patients still need to maintain good living habits after surgery to consolidate the weight loss effects. While the behavioral guidelines are relatively mature, patient's behavioral compliance is not ideal, resulting in a high rate of postoperative weight regain. In that case, we can depend on strategies to promote dietary and physical activity behaviors in patients from the cognitive perspective.

Objective

To systematically code and merge the dietary and physical activity behavior promotion strategies after bariatric surgery from the cognitive perspective.

Methods

In June 2022, the WHITTEMORE and KNAFL's integrative review methodology was used. Studies written in English related to dietary and physical activity behavior promotion strategies after bariatric surgery were searched in databases of PubMed, Web of Science, the Cochrane Library and CINAHL, and those in Chinese were searched in databases of CNKI and Wanfang Data from January 1994 to June 2022. The 2016 version of the Critical Appraisal Skills Program (CASP) was used to evaluate the quality of the literature. Studies meeting the inclusion criteria were included, and the strategies extracted from which were uniformly coded and merged according to the CALO-RE taxonomy.

Results

A total of 25 studies were included, including 17 randomized controlled trials, 4 observational studies, and 4 reviews. After coding, all strategies were covered by CALO-RE taxonomy, involving 25 kinds, mainly including self-monitoring of behavior, social support, goal setting, identifying barriers/problem resolution, etc. A total of 46 strategies were obtained and used to create a strategy set named "promotion strategies of dietary and physical activity behaviors after bariatric surgery".

Conclusion

Through the application of the integrative review methodology and the guidance of CALO-RE taxonomy, this study systematically coded and merge the dietary and physical activity behavior promotion strategies from the cognitive perspective for applicable to patients after bariatric surgery, providing a reservoir of techniques for postoperative behavioural management. After assessing patients' behavioural levels and cognitive factors, bariatric surgery providers can select appropriate strategies to improve patients' behavioural compliance. This strategy set can be further validated and optimised in future empirical studies.

Characteristic and Predictive Factors of Food Preference Changes in Patients Undergoing Bariatric Surgery

YANG Ningli, HUA Hongxia, XU Qin, LIANG Hui

2023, 26(07):  800-809.  DOI: 10.12114/j.issn.1007-9572.2022.0772

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Background

The change of food preference after bariatric surgery is an important factor affecting postoperative weight loss. It is particularly important to assess the specific characteristics and predictive factors of food preference changes after the surgery. It is difficult to guide postoperative weight maintenance based on the large variability in results between available studies.

Objective

To investigate the characteristics of food preference change and its effect on weight loss outcomes in patients undergoing bariatric surgery, and to analyze the predictive factors of food preference change.

Methods

A convenient sampling method was used to select 245 patients undergoing bariatric surgery who were admitted to Outpatient Weight Loss Follow-up Department, the First Affiliated Hospital of Nanjing Medical University from February to August, 2022. The self-developed General Demographic Questionnaire, Weight Loss Outcome Questionnaire and Food Preference Change Features after Bariatric Surgery were used to collect relevant data. Independent samples t-test was used to compare the effects of changes of food preference after bariatric surgery on the weight loss outcome. Univariate analysis and disordered multi-class Logistic regression were performed to analyze the predictive factors of food preference changes after bariatric surgery.

Results

Two hundred and thirty-seven (96.7%) patients who returned responsive questionnaires were finally enrolled, and 97.0% of them had food preference changes after bariatric surgery. Patients with and without changes in food preferences after bariatric surgery had statistically significant differences in postoperative weight, body mass index drop value and total weight loss percentage (P<0.05) . Disordered multi-class Logistic regression analysis showed that postoperative time was the predictor of changes in preferences of patients undergoing bariatric surgery for vegetables and fruits (P<0.05) ; marital status and preoperative comorbidities were predictors of changes in preference of patients undergoing bariatric surgery for high-quality protein foods (P<0.05) ; place of residence (northern or southern China) was the predictor of changes in preference of patients undergoing bariatric surgery for spicy foods (P<0.05) ; gender, place of residence and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for salty snacks (P<0.05) ; gender and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for high-fat meat (P<0.05) ; gender and postoperative time were predictors of changes in preferences of patients undergoing bariatric surgery for sweet food (P<0.05) ; gender and bariatric surgery methods were predictors of changes in preferences of patients undergoing bariatric surgery for sweet drinks (P<0.05) .

Conclusion

The incidence of food preference changes in patients undergoing bariatric surgery is high, showing a decrease in their preference for high calorie foods and an increase in their preference for healthy foods. Gender, marital status, place of residence, preoperative comorbidities, bariatric surgery methods, and postoperative time are predictors of various food preference changes in patients undergoing bariatric surgery. Weight loss professionals should identify the target population at early stage, pay more attention to postoperative dietary education and guidance for patients, in order to improve the postoperative dietary experience and effectively ensure the effect of bariatric surgery.

Reliability and Validity of the Chinese Version of Repetitive Eating Questionnaire for Patients Undergoing Bariatric Surgery

HUA Hongxia, LIANG Hui, XU Qin, ZHU Hanfei, YANG Ningli

2023, 26(07):  810-815.  DOI: 10.12114/j.issn.1007-9572.2022.0694

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Background

The grazing behavior after bariatric surgery is significantly related to postoperative weight regain, and its incidence will increase with the extension of time after surgery. So it is particularly important to early detect and accurately evaluate the grazing behavior of patients undergoing bariatric surgery. At present, the assessment tools for grazing behavior in these patients in China are still lacking.

Objective

To translate the Repetitive Eating Questionnaire〔Rep (eat) -Q) 〕into Chinese and evaluate its reliability and validity among patients undergoing bariatric surgery.

Methods

The Brislin's model of translation was adopted for translation. We developed the Chinese version of Rep (eat) -Q following the process of translation of the English version of the Rep (eat) -Q, back translation, expert review and a pilot study. On 2022-08-31, patients undergoing bariatric surgery admitted to the bariatric follow-up clinic of the First Affiliated Hospital with Nanjing Medical University from March to August 2022 were selected for the study using convenience sampling. Then we used the general information questionnaire, Chinese version of Rep (eat) -Q and the 21-item Three-Factor Eating Questionnaire (TFEQ-R21) to conduct a survey among 294 patients undergoing bariatric surgery to test the reliability and validity of the Chinese version of Rep (eat) -Q.

Results

According to the score of the Chinese version of Rep (eat) -Q, these patients were divided into high-score group (n=79) and low-score group (n=78) by the critical ratio. High-score group scored higher in each item of the Chinese version of Rep (eat) -Q compared with the low-score group (P<0.05) . The score of each item in the Chinese version of Rep (eat) -Q was linear positively correlated with the total score (r=0.368-0.782, P<0.05) . The value of Cronbach's α for the scale, repetitive eating subscale and compulsive grazing subscale was 0.943, 0.928 and 0.898, respectively. The value of split-half reliability for the scale, repetitive eating subscale and compulsive grazing subscale was 0.835, 0.938 and 0.891, respectively. And the value of test-retest reliability of the scale, repetitive eating subscale and compulsive grazing subscale was 0.867, 0.800, and 0.836, respectively. The item-level content validity index (CVI) ranged from 0.80 to 1.00. The scale-level CVI /universal agreement and S-CVI/average were 0.92 and 0.98, respectively. Two common factors were obtained after varimax orthogonal rotation by principal component analysis, whose eigenvalues were 7.086, and 1.596, respectively, explaining 72.35% of the total variance. The factor loading values of all items ranged 0.637 to 0.878. The confirmatory factor analysis indicated that the values ofχ²/df, GFI, AGFI, NFI, IFI, CFI and RMSEA were 2.211, 0.905, 0.860, 0.920, 0.955, 0.954, and 0.080, respectively. 294 patients' total score of the Chinese version of Rep (eat) -Q showed a significant correlation with three dimensions of the TFEQ-R21 (P<0.05) .

Conclusion

The Chinese version of Rep (eat) -Q has good reliability and validity, and is simple and easy-to-operate, which can be used to assess the grazing behavior among Chinese patients undergoing bariatric surgery.

Original Research·Focus on Population Health

High-precision Identification and Prediction of Spatio-temporal Evolutionary Patterns of Overweight among Children under 5 in China

ZHANG Xiyu, LI Ye, WU Qunhong, LI Jida, HU Yu

2023, 26(07):  816-824.  DOI: 10.12114/j.issn.1007-9572.2022.0648

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Background

The trend of prevalence and severity of the overweight problem in young children, reduces the general quality of the future population to a certain extent, inducing a great risk to the sustainable development of health human capital stock in China.

Objective

To scientifically understand the spatio-temporal evolutionary patterns and future development trends of overweight rates among children under 5 in China, in order to provide support for controlling overweight in children, improve the efficiency of local governance and support for the implementation of precise interventions.

Methods

In April 2022, the 5 km×5 km gridded dataset in 105 middle-and low-income countries provided by the Institute for Health and Evaluation at the University of Washington (IHME) was used as the data source to extract the gridded data of overweight rates among children under 5 in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region and Taiwan District) from 2000 to 2019 in this study. The average overweight rate of children under 5 from 2000 to 2019 was calculated pixel-to-pixel, the Theil-Sen estimator, Mann-Kendall test and Hurst index estimation method was used to characterize the spatio-temporal evolutionary patterns and future development trends among children under 5 pixel-to-pixel.

Results

Overweight among children under 5 is more prevalent in most regions of Shandong Province, Hunan Province and local regions of Fujian Province, Guangdong Province, Hainan Province, Beijing Municipality and Tianjin Municipality during the 20-year period from 2000 to 2019, with the average overweight rate of children under 5 in Hunan Province reaching 29.42%. The area of the regions with significant increase in overweight rates among children under 5 accounts for 60.59% of the total area of the regions in the study (excluding regions with missing data) . The area of the central and eastern regions with a significantly increasing trend in the overweight rates among children under 5 accounts for a higher proportion of the total area of central and eastern regions (excluding regions with missing data) than the proportion accounted by the area of the western regions with a significantly increasing trend in the overweight rates among children under 5 of the total area of western regions (excluding regions with missing data) . The area of the regions with no significant change in the evolution trend of overweight rates accounts for 25.33% of the total area of the regions in the study, which is scattered in patches in parts of provinces, such as cities cluster in the middle reaches of the Yangtze River urban agglomeration. The area of the regions with significant change in the evolution trend of overweight rates accounts for 14.08% of the total area of the regions in the study, concentrated in some regions in the Xinjiang Uygur Autonomous Region, Qinghai Province, Sichuan Province and Yunnan Province in the west of China, and local regions of Hebei Province, Liaoning Province and Shandong Province in the east of China. According to the Hurst index, the area of the regions with persistent or trend-enhancing characteristics of the time series of overweight rates of children under 5 accounts for 84.87% of the total area of the regions in the study.

Conclusion

The spatial heterogeneity of overweight rates among children under 5 in China is obvious. There is a synergistic "U"-shaped association between the overweight rates of children under 5 and the overall level of regional development, the association implies a multi-stage, cascading developmental process of "declining stage of stunting" "stabilization stage" "rising stage of overweight with overnutrition". Focusing on social problems derived from the coupling of multidimensional factors of overweight in young children, the results of the study provide scientific support and policy reference for the government to formulate region-specific policies, build a three-level governance network of "government policy regulation - social concept penetration - family health management", and scientifically and precisely solve the overweight problem among children under 5.

The Helicobacter Pylori Antibiotic Resistance in Wenzhou, Zhejiang from 2013 to 2020

DU Junyan, PAN Jie, ZHOU Qingjie, TANG Qingqing, YANG Ningmin, ZHANG Jianzhong

2023, 26(07):  825-829.  DOI: 10.12114/j.issn.1007-9572.2022.0575

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Background

Helicobacter pylori (H. pylori) infection is the main cause of gastric cancer, but with the increase of H. pylori antibiotic resistance, the eradication rate has not substantially improved in many areas.

Objective

To understand the H. pylori antibiotic resistance situation in Wenzhou from 2013—2020, and analyse the difference of H. pylori antibiotic resistance with time period, age and gender.

Methods

From 2013-01-01 to 2020-12-31, a total of 47 658 patients undergoing gastroscopy in Wenzhou Central Hospital were selected. Gastric mucosa specimens were collected for H. pylori isolation and culture, and the isolated H. pylori strains obtained from the culture were analyzed for drug susceptibility to six antibiotics, including levofloxacin, clarithromycin, amoxicillin, metronidazole, tetracycline and furazolidone. A chi-square test was used to compare H. pylori antibiotic resistance rate between years, age groups and sexes.

Results

Multiple antibiotic resistance existed in 16 847 H. pylori strains isolated in Wenzhou from 2013—2020. Separate statistics on the resistance rates of H. pylori to the six commonly used antibiotics revealed that the resistance rates to levofloxacin, clarithromycin and metronidazole were high in the region, respectively 32.81% (5 536/16 874) 、26.02% (4 390/16 874) 、95.67% (16 144/16 874) . The resistance rate to amoxicillin was low, only 0.28% (47/16 874) , and 1.36% (25/1 844) in 2017. No strains were found with resistance to tetracycline hydrochloride and furazolidone. From 2013 to 2020, there were statistically significant differences in H. pylori resistance rates to levofloxacin, clarithromycin and amoxicillin (P<0.01) . The metronidazole resistance rate in H. pylori was consistently high (>88.00%) with no statistical difference (P>0.05) . There was statistically significant difference in the H. pylori resistance rate for evofloxacin, clarithromycin and metronidazole between female and male (P<0.01) , with no statistical difference for amoxicillin (P>0.05) . There was statistically significant difference in the H. pylori resistance rate for levofloxacin or clarithromycin among different age groups in the region (P<0.01) , with no statistical difference for amoxicillin and metronidazole (P>0.05) .

Conclusion

The H. pylori antibiotic resistance rate differed by year, and varied across different age and sex groups of H. pylori-positive cases in Wenzhou during the period. The overall H. pylori resistance rate was high. The eradication regimens based on metronidazole, clarithromycin or levofloxacin are difficult to achieve satisfactory results, so clinical H. pylori eradication treatment based on drug sensitivity test results should be encouraged.

Health Equity and Its Decomposition Analysis among Middle-aged and Older Adults in Pilot Counties of the Ningxia Hui Autonomous Region

MA Ximin, LI Peiwen, HE Jiahui, YANG Jiafei, QIAO Hui

2023, 26(07):  830-835.  DOI: 10.12114/j.issn.1007-9572.2022.0559

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Background

With the severe situation of the increasingly population aging in China, the health problems of the middle-aged and older adults can not be ignored, attracting much attention on the health equity among the rural-dewlling middle-aged and older adults. The geographic remoteness of southern mountainous area in the Ningxia Hui Autonomous Region causes the health conditions of the middle-aged and older adults more unoptimistic. However, there are relatively few studies on the health equity among the middle-aged and older adults in this area.

Objective

To investigate the health equity of the middle-aged and older adults in the pilot counties of medical reform in the Ningxia Hui Autonomous Region (Haiyuan County and Yanchi County) and analyze the contribution degree of various influencing factors to health inequality, so as to provide a basis for improving the health of the middle-aged and older adults and relevant health policies.

Methods

From January to March in 2022, from the follow-up data of 2019 from the Family Health Inquiry Survey of Rural Residents, the middle-aged and older adults (age≥45 years old) from resident families (living in the corresponding counties for more than one year) were selected as subjects (n=5 908) . The analysis was conducted with the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate as dependent variables, with sex, age, marital status, level of education, occupation, type of drinking water and per capita family income as independent variables. The concentration index was used to analyze the health equity of the middle-aged and older adults, and the centralized index decomposition method was used to analyze the contribution of various influencing factors to health inequality.

Results

The concentration indexes of two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Haiyuan County were 0.030 0, 0.002 9, 0.011 4 and 0.032 7, respectively, while those of two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Yanchi County were 0.000 4, -0.000 1, 0.037 4 and 0.037 4, respectively. The concentration index decomposition analysis showed that gender, age, level of education, occupation, type of drinking water and per capita family income are the main causes for health inequality among the middle-aged and older adults, among which age and per capita family income contribute more to health inequality. The contribution ratio of age to the two-week prevalence rate, hronic disease prevalence rate, two-week bedridden rate and two-week leaving rate in Haiyuan County were -11.92%, -152.57%, -27.76% and 7.80%, respectively. The contribution ratio of age to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate in Yanchi County were -334.79%, 1 117.94%, -45.45% and-25.44%, respectively. The contribution ratio of per capita family income to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Haiyuan County were 35.41%, -0.31%, 2.08% and 22.03%, respectively. The contribution ratio to the two-week prevalence rate, chronic disease prevalence rate, two-week bedridden rate and two-week leaving rate among the middle-aged and older adults in Yanchi County were 86.88%, -165.24%, 37.13% and 1.50%, respectively.

Conclusion

Overall, the health equity among the middle-aged and older adults in the pilot counties of the Ningxia Hui Autonomous Region is better but tilted towards those with higher incomes. Age contributes the most to health inequity among the middle-aged and older adults. The society should give higher priority to the middle-aged and older adults; Local primary health care institutions can increase the health awareness of the middle-aged and older adults by providing free health check-ups regularly and promoting health literacy to them. The health administration should adjust relevant health policies to better meet the health needs of the middle-aged and older adults and ultimately achieve health equity.

Development, Reliability and Validity of Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Offspring and Grandchildren during Caring the Elderly

WANG Yu, HAO Xijun, CHEN Changxiang, ZHU Ying

2023, 26(07):  836-842.  DOI: 10.12114/j.issn.1007-9572.2022.0624

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Background

With the aggravation of aging trend, the influence of intergenerational support on the health of the elderly has gradually attracted attention, and the absence of spiritual care and life care is an important factor for the occurrence of health problems in the elderly, but there is a lack of scientific evaluation tools to evaluate the cognitive level of old-age care.

Objective

To develop a Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Offspring and Grandchildren in the process of elderly care, and to test its reliability and validity.

Methods

From April to July 2021, the first draft of the questionnaire was determined by searching relevant contents in databases such as PubMed, Web of Science, China Knowledge Network and Wanfang Data Knowledge Service Platform, and using the theory of knowledge, attitude and practice and Maslow's hierarchy of needs as the theoretical framework, combined with literature review, national maintenance laws, qualitative interviews, the questionnaire was refined with results of the Delphi expert consensus and pre-survey. From October 2021 to March 2022, 270 subjects from each generation were selected for the formal survey and 50 subjects from the offspring and 38 subjects from the grangchildren were selected for test-retest reliability using the random cluster sampling method. A total of 540 questionnaires were distributed, 270 questionnaires for each generation. A total of 528 valid questionnaires were returned, 264 valid questionnaires for each generation, with a valid return rate of 97.8%. Its reliability and validity were analyzed to determine the final questionnaire entry.

Results

The Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Offsprings included 3 dimensions and 34 items. Exploratory factor analysis produced 3 factors, with a cumulative variance contribution rate of 64.455%. The content validity of each item ranged from 0.867 to 1.000, and the average content validity of the questionnaire was 0.967. Cronbach's α coefficient was 0.953, split-half reliability was 0.811, and test-retest reliability was 0.987. The Knowledge, Attitude and Practice about Filial Piety Ethics Questionnaires for Grandchildren consisted of 31 items in 3 dimensions. Exploratory factor analysis produced three factors, the cumulative variance contribution rate was 64.641%; the content validity of each item ranged from 0.867 to 1.000, the average content validity of the questionnaire was 0.964; Cronbach's α coefficient was 0.952, split-half reliability was 0.837, and test-retest reliability was 0.991.

Conclusion

The developed questionnaire has good reliability and validity, and can be used as a research tool to evaluate the current status of filial piety ethic knowledge, attitude and behavior of offsprings and grandchildren in the process of elderly care.

Original Research·Focus on Clinical Practice and Improvement

Behavioral Characteristics of Physician Participation in Shared Decision-making: a Mixed-methods Study

YANG Linning, ZHENG Hongying, XU Yurui, YANG Yan

2023, 26(07):  843-852.  DOI: 10.12114/j.issn.1007-9572.2022.0548

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Background

Shared decision-making is a practice that fully reflects the idea of patient-centered care, but its clinical implementation process is not ideal. Physicians are main participants to promote the implementation of shared decision-making, but there are few studies on their behaviors in shared decision-making.

Objective

To explore the process and main behavioral characteristics of physicians' participation in shared decision-making, offering evidence for the promotion and implementation of shared decision-making in clinical practice.

Methods

A mixed-methods convergent design was used to collect quantitative and qualitative data. In the quantitative study, convenience sampling method was used to select in-service physicians (n=360) from a grade A tertiary hospital in Shanghai to attend a questionnaire survey from May to December 2020 to understand the status of their participation in shared decision-making. K-means clustering was conducted to analyze the distribution characteristics of physicians' participation in shared decision-making. In the qualitative study, 23 physicians selected from the participants of the quantitative study using convenience sampling and purposive sampling from June to December 2020 were recruited to attend semi-structured interviews to explore the process and experience of their participation in shared decision-making and identify the main behavioral characteristics of them in each part of the process of shared decision-making.

Results

Quantitative data analysis: in all, 325 (90.3%) of the physicians who returned responsive questionaries were included for analysis. The average total score of their participation behavior in shared decision-making was (80.44±14.88) . The further analysis found that physicians had the highest participation in behaviors of "Explain the advantages and disadvantages of the treatment options to my patient" (4.38±0.74) and "I told my patient that there are different options for treating his/her medical condition" (4.30±0.84) ; physicians had the lowest participation in behaviors of "I made clear to my patient that a shared decision needs to be made" (3.72±1.22) and "My patient and I selected a treatment option together" (3.74±1.03) . The results of cluster analysis showed that the behavioral characteristics of physicians' participation in shared decision-making could be divided into three groups, namely informed consent group, partial patient participation group and shared decision-making group. Qualitative data analysis: physicians' participation behaviors in shared decision-making included building up the awareness of shared decision-making, providing the patient with information, examining patient comprehension of the information, clarifying patient values, co-assessment (of the feasibility of the options) , reaching a decision and decision implementation. Analysis of the mixed-methods research results showed that in the decision-making process, physicians paid more attention to the provision of information, and ignored the behavioral factors of promoting patient participation at the level of doctor-patient communication. The behavioral characteristics of physicians' participation in shared decision-making were different.

Conclusion

The physicians' participation behavior in shared decision-making was limited. And they may have misunderstandings about the behavior process of shared decision-making. To promote the practical implementation of shared decision-making in clinical practice, it is suggested to help physicians clarify the process of shared decision-making via interventions enhancing their knowledge and attitudes regarding shared decision-making, deepen their understanding of shared decision-making through scenario simulation and role-playing, and improve their recognition of patient values in decision-making.

The Level and Influencing Factors of Health Assessment for Hypertensive Patients by Primary Care Physicians

WANG Nameng, LIAO Kang, LI Liqi, WEI Rongrong, BAI Xueting

2023, 26(07):  853-861.  DOI: 10.12114/j.issn.1007-9572.2022.0777

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Background

Primary care physicians play a vital role in the health management of hypertensive patients. Health assessment is an important tool for screening, diagnosis, and risk prediction of hypertension. Risk assessment allows early detection of target organ damage in hypertensive patients and provides a basis for treatment planning. Currently, the national public health service specification has clear requirements for health assessment for hypertensive patients, and such assessments have been carried out in primary health care institutions, but there are few reports on the competence of primary care physicians in health assessment for hypertensive patients.

Objective

To understand the levels of knowledge, attitude and practice (KAP) about health assessment for hypertensive patients among primary care physicians, and to analyze their influencing factors.

Methods

From May to June 2022, an online questionnaire survey was conducted among a multistage stratified sample of 420 primary care physicians in northern, central and southern Shanxi Province for collecting information of their baseline demographics, levels of KAP for health assessment for hypertensive patients, and hypertension assessment devices equipped in their medical institutions. Multiple linear regression was used to identify factors associated with primary care physicians' level of health assessment for hypertensive patients.

Results

A total of 402 cases (95.7%) who returned responsive questionnaires were finally included. The total average score of KAP of the primary care physicians on the health assessment for hypertensive patients was (127.16±18.65) , with an average score of (53.68±8.95) on the knowledge dimension, (28.62±4.09) on the attitude dimension and (44.86±7.53) on the practice dimension. The results of multiple linear regression analysis showed that work unit, the level of highest educational attainment, specialty, participation in standardized training, learning the latest National Guidelines for the Management of Primary Hypertension in Primary Care, receiving health management-related training, frequency of learning chronic disease knowledge and skills organized by their medical institutions, and weekly hours of independent learning were associated with the knowledge dimension of hypertension health assessment among primary care physicians (P<0.05) . The participation in standardized training, mode of employment, learning the latest National Guidelines for the Management of Primary Hypertension in Primary Care, frequency of learning chronic disease-related knowledge and management skills organized by their medical institutions, and weekly hours of independent learning were factors influencing primary care physicians' scores on the attitude dimension of hypertension health assessment (P<0.05) . Acquisition of physician qualifications, the participation in standardized training, learning the latest National Guidelines for the Management of Primary Hypertension in Primary Care, receiving health management-related training, frequency of learning chronic disease-related knowledge and management skills organized by their medical institutions, and weekly hours of independent learning were factors influencing primary care physicians' scores on the behavioral dimension of hypertension health assessment (P<0.05) . In terms of the hypertension assessment equipment equipped in the medical institutions of primary care physicians, except for sphygmomanometer, height and weight measuring instruments and soft rulers for measuring waist circumference with a configuration rate of more than 96.8%, the configuration rates of routine hematology analyzers, routine urine chemistry analyzers, blood biochemistry analyzers, electrocardiogram machines, and chest X-ray (radiography) equipment (35.6%, 35.8%, 26.9%, 42.8%, and 23.1%, respectively) were all less than 45.0%, and the configuration rates of ambulatory blood pressure monitor, cardiac ultrasound machines, vascular color Doppler ultrasound equipment and funduscopic examination equipment were even lower (less than 15.0%) .

Conclusion

Primary care physicians have a relatively positive attitude toward health assessment for hypertensive patients, and there is still room for improvement in their levels of related knowledge and practical skills. In the future, we can improve primary healthcare services and standards by strengthening the standardized training of professional knowledge and skills of primary care physicians, improving the incentive and assessment system of primary healthcare institutions, and stimulating the awareness of independent learning of primary care physicians.

Allergic Rhinitis-related Knowledge, Diagnosis and Treatment among General Practitioners in Chaoyang District, Beijing

CHEN Ning, ZHAO Yali

2023, 26(07):  862-868.  DOI: 10.12114/j.issn.1007-9572.2022.0415

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Background

Allergic rhinitis (AR) is a highly prevalent chronic non-communicable disease. The research on the understanding and treatment of AR in China is mainly in otorhinolaryngology specialists, but rarely in general practitioners (GPs) in primary care. And recommendations on the diagnosis and treatment of AR in primary care are also insufficient.

Objective

To explore the understanding of AR and diagnosis and treatment capacities related to AR in GPs in primary care.

Methods

By use of simple random sampling, 432 GPs from 21 community health service organizations in Beijing's Chaoyang District were chosen between August and September 2020. The questionnaire was combined with the Guidelines for the Diagnosis and Treatment of Allergic Rhinitis (Tianjin, 2015) (China 2015 AR Guidelines) and Allergic Rhinitis and Its Impact on Asthma (ARIA) Guidelines: 2010 Revision, and its 2016 annual revision, and refinement of the questionnaire after consultation with experts and pre-survey. The information obtained from the questionnaire included basic information about the subjects, understanding level, diagnostic and therapeutic behaviors, training, and support needs regarding AR, et al.

Results

The 383 (88.7%) of the 432 questionnaires were finally returned. Only 0.8% (3/383) of the GPs correctly responded to all of the questions on typical AR symptoms, diagnosis, treatment philosophies, first-line drug classes, and regimens suggested by guidelines. Guidelines for AR, including China 2015 AR Guidelines and ARIA Guidelines, were known to 32.4% (124/383) of the GPs, Web-based continuing education such as www.haoyisheng.com, www.dxy.cn and WeChat and related training. When treating each patient with a respiratory illness, the prevalence of GPs differentiating AR from others, providing recommendations on environmental control, suggesting nasal rinsing, recommending other treatments instead of immunotherapy, and referring the patient to the specialty department without any treatment, was 59.8% (229/383) , 37.1% (142/383) , 17.8% (68/383) , 49.4% (189/383) , and 13.1% (50/383) , respectively. In terms of pharmacological treatment, 17.5% (67/383) of GPs said their hospital offered all four classes of first-line AR medications. As for AR-related training, 75.7% (366/383) of the GPs reported not having taken any AR-related training in 2019; and 91.7% (266/290) needed the training. And 95.6% (290/383) of the GPs said AR should be handled standardizedly in the community. A multivariate stepwise regression Logistic analysis revealed that when encountering patients with respiratory symptoms, GPs with a master's degree or higher〔OR (95%CI) =2.790 (1.057, 7.366) 〕and a good grasp of AR-related health knowledge〔OR (95%CI) =3.537 (2.015, 6.209) 〕were more likely to make a differential diagnosis of AR from other illnesses, GPs with a good grasp of AR-related health knowledge〔OR (95%CI) =4.397 (0.534, 1.576) 〕were more likely to offer patients guidance on environmental control behaviors, GPs who were familiar with nasal irrigation procedures〔OR (95%CI) =6.592 (3.038, 14.306) 〕were more likely to recommend nasal irrigation, and GPs knowing about immunotherapy〔OR (95%CI) =1.881 (1.087, 3.254) 〕, accurately answering questions on the principles of treatment〔OR (95%CI) =128.330 (16.628, 990.402) 〕or their institution providing some/all laboratory testing services〔OR (95%CI) =2.210 (1.299, 3.760) 〕were prone to recommend immunotherapy.

Conclusion

Despite their low awareness levels of AR expertise and guidelines, and unsatisfied practice standardization, GPs in primary care in Chaoyang District demonstrated proactive attitude towards continuing education and carrying out standardized AR treatment in primary care. As high awareness levels of AR-related knowledge and guidelines promote the practice standardization, relevant trainings for GPs in primary care should be strengthened, and AR-related guidelines applicable to primary care should be developed, which can provide support for the standardization of AR treatment at the primary care level.

Analyze Mastery of Atrial Fibrillation Related Knowledge and Its Influencing Factors among Grassroots Medical Staffs

DUAN Yuanxia, GU Liuna, ZHANG Lei, ZHOU Liting, ZHU Haiying, YANG Chao, CHEN Haiying, GU Xiaoqing, HUANG Jiaoling, GU Jie

2023, 26(07):  869-876.  DOI: 10.12114/j.issn.1007-9572.2022.0405

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Background

With the aging of the population, the prevalence of atrial fibrillation is increasing year by year. As the "gatekeepers" of community residents' health, grassroots medical staff with a high level of knowledge about atrial fibrillation is particularly important for standardized management of atrial fibrillation.

Objective

To analyze the mastery of atrial fibrillation-related knowledge among grassroots medical staff in Fengxian District, Shanghai and its influencing factors, thus, providing a theoretical basis for subsequent training work.

Methods

This study is a cross-sectional survey study. From June to July 2021, a systematic sampling method was used to select 1 393 grassroots medical staff as the research objects including general practitioners, nurses, pharmacists, public health physicians and other medical staff (imaging technology/physician, laboratory technician, traditional Chinese medicine doctor and so on) from 21 community health service centers in Fengxian District, Shanghai. This study used a self-developed electronic questionnaire to investigate them. The contents of the questionnaire included general information and knowledge related to atrial fibrillation (basic knowledge about atrial fibrillation, knowledge about anticoagulant therapy and knowledge about rhythm/heart rate control) . This study compared the mastery of atrial fibrillation-related knowledge among grassroots medical staff in different positions, and used univariate Logistic regression, ordinal multiple classification or binary Logistic regression to analyze the influencing factors of grassroots medical staff's mastery of atrial fibrillation-related knowledge.

Results

A total of 1 383 valid questionnaires were recovered, and the valid questionnaire recovery rate was 99.28%. Among 1 383 grassroots medical staff, 506 cases (36.59%) were general practitioners. 54.88% (759/1 383) , 97.69% (1 351/1 383) and 69.63% (963/1 383) failed in the basic knowledge about atrial fibrillation, knowledge about anticoagulation and knowledge about heart rhythm/heart rate control, respectively. There were statistically significant differences in the scores of atrial fibrillation knowledge, anticoagulation knowledge and heart rhythm/heart rate control knowledge among grassroots medical staff in different positions (P<0.05) . Ordinal multiple classification or binary Logistic regression analysis showed that the position as a general practitioner and professional title were the influencing factors of score in the basic knowledge related to atrial fibrillation among grassroots medical staff (P<0.05) . Age and position as a general practitioner were the influencing factors of whether the score in knowledge related to anticoagulation therapy reaches the pass level or above among grassroots medical staff (P<0.05) . The position as a general practitioner, received standardized training and reading the atrial fibrillation guideline within one year were the influencing factors of the score in knowledge related to heart rhythm/heart rate control among grassroots medical staff (P<0.05) .

Conclusion

The mastery of knowledge about atrial fibrillation among grassroots medical staff is generally not ideal, especially the lack of knowledge about anticoagulation therapy. Atrial fibrillation related knowledge training should be especially strengthened for grassroots medical staff who are not general practitioners, have low professional titles, and have not received standardized training.

Perceptions of Chronic Obstructive Pulmonary Disease among Chronic Disease Managers in Primary Care in Rural Areas

LIU Jiancai, ZHENG Hanyin, PAN Hui, YE Linglan, LI Chuanfen

2023, 26(07):  877-885.  DOI: 10.12114/j.issn.1007-9572.2022.0363

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Background

Non-communicable disease (NCD) managers are the main force in the prevention and treatment of chronic obstructive pulmonary disease (COPD) . Understanding the perceptions of COPD among NCD managers in primary care in rural areas can provide a scientific basis for enhancing future prevention and management of COPD in primary care.

Objective

To investigate the perceptions of COPD in NCD managers in rural primary care, offering a scientific basis for the improvement of COPD prevention and management in primary care.

Methods

In June 2021, random sampling method was used to select 20 township hospitals in Zigong, Sichuan Province, and from which NCD managers〔including general practitioners (GPs) , public health workers and rural doctors〕were selected by use of cluster sampling. A survey was conducted with them using a self-developed questionnaire (consisting of two parts: general demographics and COPD-related knowledge) for understanding their perceptions of COPD.

Results

All the cases (n=474) who participated in the survey returned responsive questionnaires, achieving a response rate of 100.0%, including 68 GPs (14.4%) , 177 public health workers (37.3%) , and 229 rural doctors (48.3%) . With regards to answering the questions of comprehensive COPD knowledge, GPs had statistically significant higher pass rate than rural doctors〔35.3% (24/68) vs 7.4% (17/229) 〕 (P<0.017) , and public health workers also had statistically notably higher pass rate than rural doctors〔31.6% (56/177) vs 7.4% (17/229) 〕 (P<0.017) . In terms of answering the questions about risk factors of COPD, GPs had statistically significant higher pass rate than rural doctors〔73.5% (50/68) vs 46.3% (106/229) 〕 (P<0.017) , and so did public health workers〔66.7% (118/177) vs 46.3% (106/229) 〕 (P<0.017) . In terms of answering the questions about diagnosis and evaluation of COPD, GPs had statistically significant higher pass rate〔38.2% (26/68) 〕than public health workers〔20.3% (36/177) 〕or rural doctors〔3.9% (9/229) 〕 (P<0.017) , and the pass rate of public health workers was statistically significant higher than that of rural doctors (P<0.017) . In terms of answering the questions about treatment strategies for COPD, GPs had statistically significant higher pass rate than rural doctors〔30.9% (21/68) vs 6.6% (15/229) 〕 (P<0.017) , and so did public health workers〔19.2% (34/177) vs 6.5% (15/229) 〕 (P<0.017) . In terms of answering the questions regarding follow-up management for COPD, public health workers had statistically significant higher pass rate than GPs〔46.9% (83/177) vs 29.4% (20/68) 〕and rural doctors〔46.9% (83/177) vs 14.4% (33/229) 〕 (P<0.017) . And GPs had statistically significant higher pass rate than rural doctors (P<0.017) .

Conclusion

The NCD managers in primary care in rural areas of Sichuan's Zigong have insufficient knowledge of COPD, especially its diagnosis, evaluation, treatment strategies and follow-up management. NCD managers from different positions have different perceptions of COPD, among them rural doctors have the lowest level of perception. In view of the above problems, we need to take targeted measures to improve the level of general prevention and management of COPD in rural primary care.

Review

Advances in Diagnostic Criteria for Acute-on-chronic Liver Failure

WANG Xia, YANG Jinhui, ZHENG Mengyao, JIANG Ting, XU Zhiyuan, MA Honglin

2023, 26(07):  886-892.  DOI: 10.12114/j.issn.1007-9572.2022.0493

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Acute-on-chronic liver failure (ACLF) is a severe acute liver function decompensation that occurs after an acute attack on the basis of chronic liver disease, which has attracted the attention of hepatologists worldwide due to its rapid progression and sky-high short-term mortality. As the etiology and clinical features of ACLF significantly differ across various countries/regions, there are at least ten diagnostic criteria for ACLF at home and abroad. Therefore, in this paper, we reviewed the studies related to several commonly used definitions and diagnostic criteria of ACLF, and compared the differences among the diagnostic criteria, so as to help clinicians better identify ACLF and optimize clinical decision-making, thereby improving the clinical outcomes of ACLF patients. As there are still no recognized criteria for the diagnosis of ACLF worldwide, and large variations exist between the diagnostic criteria of ACLF at home and abroad, clinicians should select the diagnostic criteria for ACLF with sufficient consideration of etiology of chronic liver disease, clinical characteristics and other factors of patients.

Fatigue in Chronic Obstructive Pulmonary Disease: a Scoping Review

WANG Tong, QUAN Haishan, TIAN Bowen, LI Ying, CUI Qianqian, LIU Yao, ZHU Huahua

2023, 26(07):  893-902.  DOI: 10.12114/j.issn.1007-9572.2022.0600

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Background

Chronic obstructive pulmonary disease (COPD) is a global public health problem with increasing incidence and mortality. Fatigue is a common complaint of COPD patients, which seriously impairs the quality of life.

Objective

To conduct a scoping review of current research status and tools about fatigue as well as fatigue-related factors in COPD, providing ideas for the development of relevant individualized intervention schemes.

Methods

Methodological framework was used. Studies on fatigue in COPD were searched from databases of Web of Science, PubMed, EmBase, CINAHL, ProQuest, the Cochrane Library, CNKI, WanFang, CQVIP, and SinoMed from inception to July 2022, and enrolled according to the inclusion and exclusion criteria. Relevant data were extracted, collected, summarized and reported.

Results

A total of 52 studies were included. Taken overall, a wide variety of assessment tools for fatigue in COPD featured by lack of multidimensionality and specificity were used, among which common were the Functional Assessment of Chronic Illness Therapy and the Fatigue Severity Scale. There were certain disparities in the incidence, duration, and severity of fatigue in COPD across studies. The main influencing factors of fatigue include sociodemographic factors, COPD-related factors, somatic factors, and psychological factors.

Conclusion

As fatigue is a major symptom that seriously declines the quality of life in COPD patients, clinical care providers need to use specific tools to accurately assess fatigue, and to develop individualized interventions to improve fatigue according to its influencing factors.